Inhaler comparison

The information here containts some estimates, but is based on multiple peer-reviewed publications. For simplicity, I’ve only included commonly used inhalers.

Commonly used inhalers contain either steroids to dampen down inflammation (known as inhaled corticosteroid or ICS), or airway openers (known as bronchodilators) which can be short-acting (relievers) or long-acting which work for 12-24 hours. Some inhalers combine different sorts of medications, such as a steroid and long-acting bronchodilator.

Most inhalers are either Metered Dose Inhalers (MDI) which contain HFA propellant, or Dry Powder Inhalers (DPI) which don’t and therefore have far smaller carbon footprints. Soft mist inhalers (respimat) use a watery spray driven by a spring, so these also have a small carbon footprint.

Click here to jump to different classes of inhalers or perform a search on this page.


Blue reliever inhaler (short acting) – Salbutamol

Approx. 28kgCO2e per inhaler:

    • Ventolin Evohaler

Approx. 10kgCO2e per inhaler:

    • Salamol
    • AirSalb
    • Generic salbutamol inhalers

Less than 1kg per inhaler:

    • Salbutamol Easyhaler*
    • Ventolin Accuhaler
    • Terbutaline Turbohaler (contains terbutaline, not salbutamol, but works in a similar way)

Brown steroid inhalers

Approx 10-25kgCO2e per inhaler:

  • Clenil
  • QVAR
  • Beclomethasone MDIs

Approx 1kg per inhaler:

  • Budesonide Easyhaler*
  • Beclometasone Easyhaler*
  • Flixotide Accuhaler
  • Pulmicort Turbohaler

Combination steroid and bronchodilators

Approx 37kgCO2e per inhaler:

  • Flutiform
  • Symbicort MDI (the spray, not the turbohaler)

Approx. 10-25kgCO2e per inhaler:

  • Seretide evohaler
  • Fostair MDI
  • Trimbow MDI
  • Sirdupla
  • AirFluSal

Less than 1kg per inhaler:

  • Seretide Accuhaler
  • Fostair Nexthaler
  • Trimbow Nexthaler
  • Symbicort Turbohaler
  • Duoresp Spiromax
  • Relvar Ellipta
  • Trelegy Ellipta
  • Fusacomb Easyhaler*
  • Fobumix Easyhaler*

*Easyhaler devices are carbon neutral using carbon offsets certified by the carbon trust.


Other bronchodilators

These inhalers are mainly used in COPD. They come in 2 classes – Long acting Beta Agonists (LABA), long-acting Muscarinic Antagonists (LAMA) or a combination (LAMA+LABA)

Long-acting muscarinic antagonists – all low CO2e inhalers approx 1kg:

  • Spiriva Handihaler or Respimat
  • Braltus Zonda
  • Incruse Ellipta
  • Eklira Genuair

Long-acting Beta agonists

Approx 15-25kgCO2e per inhaler:

  • Serevent evohaler
  • Salmerol MDIs

Approx 1kg per inhaler:

  • Formoterol Easyhaler

Combination LAMA+LABA 

-approx 10-25kg per inhaler

  • Bevespi aerosphere

-low CO2e inhalers approx 1kg

  • Anoro Ellipta
  • Spiolto Respimat
  • Ultibro Breezhaler
  • Duaklir Genial

Key references:

Janson C, Henderson R, Löfdahl M, et al. Carbon footprint impact of the choice of inhalers for asthma and COPD

Jeswani HK, Azapagic A. Life cycle environmental impacts of inhalers. J Clean Prod. 2019;237:117733.

Goulet B, Olson L, Mayer B. A comparative life cycle assessment between a metered dose inhaler and electric nebulizer. Sustainability. 2017;9:1725

Wilkinson AJK, Braggins R, Steinbach I, Smith J. Costs of switching to low global warming potential inhalers. An economic and carbon footprint analysis of NHS prescription data in England. BMJ Open. 2019;9:e028763.

Hansel M, Bambach T, Wachtel H. Reduced environmental impact of the reusable respimat((R)) soft mist inhaler compared with pressurised metered-dose inhalers. Adv Ther. 2019;36:2487–92.

Panigone S, Sandri F, Ferri R, et al Environmental impact of inhalers
for respiratory diseases: decreasing the carbon footprint while
preserving patient-tailored treatment BMJ
 
Borenius K, Vartiainen V, Takala A, et al
P185 Life cycle assessment and cradle-to-grave carbon footprint of a multidose reservoir dry powder inhaler
 
Fulford B, Mezzi K, Whiting A, Aumônier S. Life-Cycle Assessment of the Breezhaler® Breath-Actuated Dry Powder Inhaler. Sustainability. 2021; 13(12):6657. https://doi.org/10.3390/su13126657